Athletes Training and Learning to Avoid Steroids

Athletes Training and Learning to Avoid Steroids is recommended as an exemplary
Safe, Disciplined, and Drug-Free Schools program.

Program Description

Athletes Training and Learning to Avoid Steroids (ATLAS) is a universal program for high school male athletes. The goals of the program are to reduce anabolic steroid use and intent to use, reduce the use of alcohol and other illicit drugs, reduce the use of "athletic-enhancing" supplements, reduce substance abuse risk factors, promote substance abuse protective factors, improve nutrition behaviors, and improve athletic self-efficacy.

The rationale of the program is based on the premise that student athletes are an important group for health promotion and substance abuse prevention, as they can be role models and opinion leaders for other students. Their abstinence from drug use has the potential to deter abuse in others. The success of ATLAS relies on an understanding of etiologic risks and protective factors.

ATLAS involves 10 classroom sessions (each 45 minutes long) in which students role-play, create campaigns, and play educational games. Instructional aids include pocket-sized food and exercise guides and easy-to-follow workbooks. Parents are involved with their child's homework and diet goals. The total classroom curriculum lasts nine hours. The classroom session time allotment is divided into 50 percent drug issues, 34 percent sport nutrition, and 16 percent exercise training. In addition, ATLAS requires approximately 100 hours of team contact during the sport season.

The program has two components: the Instructor Package and the Athlete Packs. The Instructor Package is a three-ring binder that includes instructions on how to train peer "squad" leaders, background information, and lesson plans for the 10-session curriculum. Also included in the Instructor Package are 10 Athlete Packs. Each Athlete Pack contains 10 curriculum workbooks, 10 sports menu booklets that feature information on nutrition and specific athletic-enhancing snacks before and after training, and 10 training guides that cover strength training, weight lifting, and workout schedules.

Program Quality

Reviewers found that the scope and sequence of the activities led logically to the achievement of the program's clearly articulated goals. They lauded the program's congruence among mission, goals, objectives, activities, and intended behavior change. This program targeted a very specific audience, and its materials were appropriate to that audience.

Evidence of Efficacy

Reviewers found that the ATLAS evaluation studies were rigorous and methodologically strong, with excellent designs, internal validity, well-known measures, appropriate analyses, and statistically significant outcomes. The program used a pre-post test design with random assignments to control groups, large samples, multiple schools, longitudinal measures, and sophisticated analyses of the data. The researchers carefully and systematically addressed issues of retention, baseline equivalence, short-term and long-term effects, and both individual and school-level results. One reviewer pointed out that the program was thoughtfully contextualized in adolescent psychological and physical development theory and correctly identified and addressed potential statistical issues, such as ethnicity and a father's education at baseline.

Reviewers noted the consistent pattern and magnitude of the program's outcomes. Each of the 14 effectiveness claims was substantiated with statistically significant results. Statistically reliable outcomes in favor of the treatment group were found in almost all areas addressed by the program. Outcomes included the following: 1) reduced incidence and prevalence of drug use, intention to use and actual use of anabolic steroids, use of sport's supplements, and incidents of drinking and driving; 2) improved drug use resistance skills and perceptions of the harmful effects of anabolic steroids--including personal susceptibility to these harmful effects, perception of athletic competence, and sports nutrition behaviors; and 3) increased strength training self-efficacy and perception of a coach's intolerance of anabolic steroid use.

The evaluation design was a randomized cohort study, conducted over three consecutive years; two cohort studies had a one-year follow-up component and all three cohort studies had an end-of-the-season follow-up. Thirty-one schools in 10 cities and two states were studied, with random assignments of pair schools to experimental and control conditions. There were 15 experimental and 16 control schools and a sample of 3,207 athletes at pre-assessment. There was no differential dropout between experimental and control groups. Positive post-test findings were observed one year after baseline measurement, using a 168-item questionnaire based on prior research that indicated high item reliabilities, validity, and adequate sensitivity.

Professional Development Resources and Program Costs

A one-day instructor and peer-led training is available but not required. Ongoing assistance and updated information are located on the ATLAS Web site, and technical assistance is available through ATLAS via e-mail, fax, and telephone. The cost of the program (Instructor Package with 10 Athlete Packs) is $149.95. Additional Athlete Packs (a set of 10) can be purchased for $39.95 each. (Current costs need to be verified with the program.)

CASASTART

The CASASTART program is recommended as an exemplary Safe, Disciplined, and Drug-Free Schools program.

Program Description

CASASTART (Striving Together to Achieve Rewarding Tomorrows) is a substance abuse and violence prevention program serving especially high-risk 8- to 13-year-olds and their families living in socially distressed neighborhoods. The program is a comprehensive, neighborhood-based, school-centered secondary intervention that brings together police, schools, and community-based organizations to achieve two goals: 1) to redirect the lives of youngsters who are considered likely to end up in trouble (e.g., likely to use drugs, become delinquent, or drop out of school), and 2) to reduce and control illegal drug use and related crime in the neighborhoods where the youths live to make the areas safer and more nurturing environments. The specific objectives of the program are to reduce children's use of illegal substances, to reduce the incidence of delinquent behavior in and out of school, and to reduce the incidence of disruptive behavior in school.

The National Center on Addiction and Substance Abuse (CASA) at Columbia University selects a low-income neighborhood in a large city and identifies a target school. Within that school, CASASTART identifies those youths most likely to become involved in negative behaviors and works to increase the protective factors in these youths to prevent their involvement in substance abuse, violence, and illegal activities. CASA's other roles are to specify the core services, train site staff, develop and sustain the collaborative relationship at the staff and policy levels, support problem-oriented policing strategies in the neighborhood, develop strategies to work through issues of confidentiality, design the data collection and management information systems, structure and conduct the program evaluation, assess local funding needs, and assist in fund development.

Program Quality

Although this program was comprehensive and took on enormous challenges, reviewers noted that the goals were still very clear and appropriate for the task. Reviewers found that the program's goals and rationale attended to the challenges of working with youths from socially distressed neighborhoods and that the program was adaptable to the variety of environments found there. CASASTART clearly addressed how the case management model was flexible in its time frame, intensity, and availability.

Evidence of Efficacy

Reviewers found considerable evidence of CASASTART's efficacy based on an independent evaluation using treatment vs. control group designs with multiple measures (e.g., surveys of youths and caregivers, court and police records, school records on performance and attendance, program records on services and participation). Reviewers commended the rigor of the evaluation design, the integrity of the measures, and the comprehensiveness of the data analyses.

CASASTART is the second iteration of the National Center on Addiction and Substance Abuse at Columbia University's Children at Risk (CAR) research and demonstration program. This program was tested in six cities from 1992 to 1995. Therefore, CASASTART provided efficacy data resulting from the 1992--95 evaluation of CAR programs in five cities. The first year of the evaluation used an experimental design in which eligible youths ages 11 to 13 were randomly assigned to treatment and control groups. The groups consisted of 338 CAR participants and 333 control youths, all selected in five cities during 1992--93 and 1993--94. During the second year of the evaluation, a second comparison group was created, using a quasi-experimental design to assign youths to comparison groups in equivalent communities who continued to recruit CAR participants. The comparison group consisted of 203 youths selected in four cities during 1993--94. Data analysis was performed to adjust for attrition, and validity was checked for self-reported data.

The evaluation data yielded statistically significant treatment and control group differences across sites between the CAR youths and the control group on measures of gateway and stronger drug use, drug sales activity, violent crimes, and involvement with delinquent peers. CAR youths had more positive peer support and felt less peer pressure. They also were more likely to be promoted to the next grade in school than were the control students.

Professional Development Resources and Program Costs

CASA's staff regularly visits new sites and provides in-service training to site staff in all components of the model. Training sessions--which involve staff from all key agencies--cover case management, service integration and collaboration, substance abuse prevention, family involvement, and community-oriented policing. CASA also holds regular all-site conference calls and an annual all-site conference, bringing together the partners from all CASA communities. A CASASTART newsletter is distributed bimonthly. (Current costs need to be verified with the program.)

Life Skills Training

Life Skills Training is recommended as an exemplary Safe, Disciplined, and Drug-Free Schools program.

Program Description

The Life Skills Training (LST) program addresses a wide range of risk and protective factors by teaching young people general personal and social skills in combination with drug resistance skills and normative education. LST is a universal, primary, school-based drug abuse prevention program that targets individual adolescents, typically in school classrooms. The goal of the program is to prevent tobacco, alcohol, and drug abuse among adolescents. The designated program consists of a three-year prevention curriculum intended for middle school and junior high students. (An elementary school curriculum has recently been developed.) The three major content areas are self-management skills, general social skills, and drug resistance skills and information.

The underlying rationale of this program is based on the premise that preventing drug use in younger populations will ultimately reduce the prevalence of drug use among these youths as they get older. LST is based on an understanding of the causes of smoking and alcohol and drug use as well as the knowledge that drug use begins due to a complex combination of many diverse factors.

Materials for each year of the LST curriculum consist of a teacher's manual, a student guide, and audiocassette tapes. The curriculum is designed to be delivered in 15 classes of approximately 45 minutes each in the first year. Ten booster sessions occur in the second year, and five sessions occur in the third year. Another option is to deliver the program as a module or mini-course so that the entire program can be conducted on consecutive days. Teachers and parents may also use a video on smoking and biofeedback to teach their students and children about the immediate harm that smoking inflicts on the body.

Program Quality

Reviewers stated that the program's goals and activities were closely aligned with research on changing knowledge, attitudes, and behaviors about drug use. Reviewers also reported that the intended population and the expected changes within that population were clearly articulated and logically appropriate.

Evidence of Efficacy

Statistically significant results were found in a wide variety of settings using randomly assigned groups, with both objective and self-report measures of use. Reviewers found consistently positive results for up to six years for participants who continued with an implementation of the program that was high in fidelity. Measures focused on the three gateway drugs: alcohol, cigarettes, and marijuana. Program measures were as reliable and valid as is possible for these complex variables, due to the fact that the program used saliva and carbon monoxide testing to validate self-reported data. Results were consistent across large numbers of participants in repeated studies.

Thirteen evaluation studies spanning more than 15 years all found strong evidence of positive treatment effects extending over periods of time. These studies used very strong research designs, controlling for threats to internal validity, such as attrition, and using follow-up components. Differential attrition was examined, and implementation fidelity of the program was assessed in most of the later studies. All studies used designs in which the schools were randomly assigned to treatment and control conditions. Reviewers found that the treatment group showed a statistically significant decrease in levels of adolescent alcohol, tobacco, and marijuana use compared with the control groups; some studies showed these effects lasting for one year or longer. The most powerful result of the program was a decrease in smoking prevalence, an outcome reinforced by a positive impact on mediating variables. A six-year longitudinal follow-up study showed statistically significant decreases in weekly and monthly cigarette smoking, getting drunk, and using multiple drugs for experimental conditions.

Almost every study showed statistically significant results that favored the treatment group, with some studies examining the strength of the program implementation and/or any differential attrition effects. In sum, reviewers concluded that the evidence as a whole showed that the program had been rigorously evaluated using a variety of populations, variations in staff, and different program formats.

Professional Development Resources and Program Costs

The LST program offers provider training at an estimated cost of $200 per person for a two-day workshop (curriculum materials not included). The training sponsor is responsible for costs associated with the training site, equipment rental, and promotion. Depending on the grade level, the teacher manuals range in cost from $45 to $85. Student guides range from $6 to $9 each. (Current costs need to be verified with the program.)

OSLC Treatment Foster Care

The OSLC Treatment Foster Care program is recommended as an exemplary Safe, Disciplined, and Drug-Free Schools program.

Program Description

The Oregon Social Learning Center (OSLC) Treatment Foster Care program recruits and trains foster families to house and care for youths with a history of juvenile delinquency. The goal of the program is to provide adolescents who are seriously delinquent and need out-of-home care with the following: close supervision, fair and consistent limits, predictable consequences for rule-breaking, a supportive relationship with at least one adult mentor, and less exposure to delinquent peers. Foster families work with caseworkers and therapists to administer an intensive behavior intervention, but biological/adoptive families continue to have input into their child's treatment.

Effective interventions for this population are multidimensional and are implemented in the Treatment Foster Care home, at school, in the community, and with peers. The program has many components, all of which work together to serve the needs of the youths. Treatment modalities include behavioral parent training for Treatment Foster Care parents and biological parents, skills training for youths, supportive therapy for youths and involved adults, school-based behavioral interventions and other academic support, and psychiatric consultation and medication management as needed. Family therapy is provided for each youth's biological and adoptive families to help achieve the ultimate goal of returning the youth home.

Placement into Treatment Foster Care homes is carefully considered and highly scripted. Youths move from a detention facility to the new home with the guidance of a case manager. Youths attend public schools, where their behavioral adjustment, attendance, and academic performance are closely monitored, and interventions are conducted in the school as needed. The program is divided into levels that participants can attain as they accumulate points for good behavior and compliance. Participants' performance in the foster home, school, and community is monitored and scored. Points earned are "redeemed" by the participants for privileges. Once a youth has returned home, parents are invited to participate in a weekly aftercare group with other parents. The aftercare curriculum is delivered through a manual titled Success Begins at Home.

Program Quality

Reviewers noted that the overall program goals were excellent and commended the program for the specific goal of realizing normal behaviors among adolescents targeted for this program. Reviewers stated that the rationale was well planned and that the content considered the diversity of the population it served. Reviewers found the expectations of performance, the interventions themselves, the methods of providing support, and the feedback all to be exemplary.

Evidence of Efficacy

Reviewers determined that the OSLC Treatment Foster Care program had been rigorously tested through four evaluation studies, one using a matched comparison design and three using random assignment designs. The program collected evaluation data through well-known measures with established reliability and validity and official organization, state, and court records. All of the evaluations were high quality in terms of experimental design, selection of measures, data analyses, and, most important, long-term effects of the program. Reviewers found its impact to be both statistically and clinically significant. The program presented convincing findings on scientifically established risk factors, such as early and persistent antisocial or aggressive behavior and early initiation of delinquency.

One randomized clinical trial of incarcerated youths ages 12 to 18 used a control group receiving an alternative treatment program. This study demonstrated statistically significant evidence of the effectiveness of the Treatment Foster Care program in reducing criminal and delinquent behaviors in serious and chronic adolescent offenders. Multiple measurement points--at baseline, three months after placement, and every six months for two years--strengthened the design. One year after treatment, the experimental group had improved in the area of conduct problems: They had fewer self-reports of delinquent activities, fewer official criminal referrals, fewer days of incarceration, and fewer days on the run from the treatment program. The matched comparison study showed that the youths from the Treatment Foster Care program spent fewer days in lockup. Also, fewer of these youths were incarcerated, and more of them completed treatment than did the comparison youths.

Professional Development Resources and Program Costs

Treatment Foster Care families are recruited and screened, and then participate in a 20-hour pre-service training. Biological and adoptive parents also receive training in point system assignments. The total program cost is estimated at $3,965 per month per youth. This total includes family therapy sessions and payments to the foster family. The average length of stay is seven months, bringing the average total cost per youth to $27,755. (Current costs need to be verified with the program.)

Project ALERT

Project ALERT is recommended as an exemplary Safe, Disciplined, and Drug-Free Schools program.

Program Description

Project ALERT is a drug-prevention program for middle-grade students that focuses on alcohol, marijuana, cigarettes, and inhalants. It was developed and evaluated at RAND with funding from the Conrad N. Hilton Foundation. Its goals are to prevent adolescents from beginning drug use, to prevent those who have experimented with drugs from becoming regular users, and to prevent or curb the risk factors demonstrated to predict drug use.

Project ALERT is based on an understanding that drug use is a social phenomenon--a response to pro-drug messages and models presented by peers, adults, and the media. This program attempts to provide the motivation for saying no by identifying the pressures to use drugs and countering pro-drug messages.

The program builds and reinforces group norms against drug use and dispels student beliefs that use is widespread, desirable, and harmless.

The curriculum consists of 11 lessons in sixth or seventh grade and three booster lessons 12 months later. The curriculum is cumulative, progressing from motivating nonuse to providing multiple opportunities to practice resistance skills and identify the benefits of resistance. Follow-up with reinforcement is contained in the booster lessons.

Program Quality

The program goals of Project ALERT clearly focused on behavioral changes that were both reasonable and appropriate for the middle-grade age level. The program content and materials were culturally and ethnically sensitive and were successfully implemented in highly diverse middle schools that encompassed urban, suburban, and rural communities. The rationale for the program was based on the social influence model of drug prevention. Students in the program were motivated and engaged in the learning process due to its participatory nature. Activities highlighted consequences of drug use that were immediately relevant to teenagers but avoided didactic lecturing and scare tactics that might have caused students to ignore or block out the message. For example, in the activity "Why not use drugs?" students reviewed a list elicited directly from their responses; thus, it automatically reflected the consequences of drug use that students themselves considered serious and likely.

Evidence of Efficacy

Reviewers determined that Project ALERT provided convincing evidence of a credible and effective drug prevention program through an extremely well-designed evaluation and consistent results. The evaluation was exemplary in all respects, including a large sample size, numerous and varied schools and student populations, two variations of program treatments, random assignment of students to treatment and control groups, longitudinal measurements, validated outcome measures, appropriate adjustment for attrition effects, and thorough and sophisticated analyses. Results demonstrated statistically significant and meaningful effects favoring the treatment students in a variety of settings and over time. Reviewers agreed that they were confident that the findings were attributable to the intervention.

The evaluation was carried out in 30 middle schools from 1984 to 1990, with three conditions of 10 schools each: 1) a control group of 1,105 students, 2) an ALERT curriculum group of 1,316 students taught by an adult teacher only, and 3) an ALERT curriculum group of 1,413 students taught by an adult teacher plus a teen leader. The evaluation design used multiple measurements to validate the self-report survey measures with physiological samples and consistency analyses conducted over time. The evaluators administered and tested saliva samples at the time of measurement to verify student survey ratings; conducted classroom observations monitoring more than one third of all lessons; examined classroom logs to ensure that materials were covered and the courses taught as they were designed; and performed a reliability test to determine inconsistencies in self-reported drug use. Data were collected at four points: before and after seventh grade and after the eighth-grade booster lessons, with follow-ups at 12 and 15 months after baseline. In addition, a long-term follow-up assessed student outcomes six years later.

Statistically significant and consistent differences were found between the treatment and control students on both their use and beliefs about use for marijuana, alcohol, and cigarettes. The evaluation examined complex relationships, including results for students who participated for different amounts of time and who began as users, nonusers, or experimenters.

Professional Development Resources and Program Costs

The Project ALERT curriculum builds the pedagogical skills and training of certified classroom teachers during a highly interactive, one-day workshop. For $125, a teacher can receive the complete training and materials package, which consists of the following: a one-day training workshop, a complete teacher's manual with 14 detailed lesson plans, two teacher demonstration videos, eight classroom videos, 12 classroom posters, an optional teen leader component, and complimentary video and print curriculum updates. Other costs for student materials are limited to a few reproducible handouts.

Ongoing support for trained Project ALERT teachers is provided through a complimentary technical assistance newsletter (published three times a year) and a toll-free teacher-assistance telephone line. Refresher workshops are available for previously trained teachers. (Current costs need to be verified with the program.)

Evaluation Information

Project Northland

Project Northland is recommended as an exemplary Safe, Disciplined, and Drug-Free Schools program.

Program Description

Project Northland is a research-based, multilevel, multiyear alcohol use prevention program for students in grades six through eight. Its goals are to delay the age when young people begin drinking, to reduce alcohol use among those who have already tried drinking, and to limit the number of alcohol-related problems among youths. The program addresses both individual behavioral change and environmental change through student participation and experiential learning at home and in peer-led classroom activities.

The sixth-grade curriculum, titled "Slick Tracy Home Team Program," is a six-session, six-week, classroom- and home-based program. Students at home with their families complete fun and educational activities that promote parent-child discussions of alcohol, peer influence, media influence, and home rules. In the classroom, small-group discussions led by peers focus on each week's theme. "Amazing Alternatives!" is a seventh-grade, teacher- and peer-led, classroom-based curriculum that is designed to be taught once or twice a week over four to eight consecutive weeks. It includes audiotaped vignettes, group discussions, class games, problem-solving tasks, and role-playing to explore why young people use alcohol and how to prevent it. Sixth- and seventh-grade peer leaders are selected by their classmates and receive training prior to curriculum implementation.

The "Powerlines" curriculum for eighth-graders is a four-week interactive program with eight 45-minute sessions. The curriculum reinforces the messages and behaviors learned in previous curricula. Through work on small-group projects, students learn about local "power" groups (individuals and organizations) and the influences those groups have on adolescent alcohol use and availability within their own communities. Students also conduct interviews with local citizens and then hold a "town meeting" in which small groups of students represent various community groups and make recommendations for community action for alcohol use prevention.

Program Quality

Reviewers noted that the program content and processes were developmentally appropriate at each grade level and took into consideration the characteristics and needs of diverse populations. The program was grounded in social influence theories such as problem behavior theory, which emphasizes the interaction of social-environmental factors, behavior, and personality in predicting adolescent drinking. Reviewers highlighted the program's design, which had students exposed to parental involvement, behavioral curricula, peer leadership opportunities, and community awareness activities during the three years of participation. Reviewers noted that roughly 70 percent of the program's small-group discussion activities were led by peers and that peer-led instruction was highly effective at this age. Project Northland used other strategies to motivate students, including class games, videotapes, and small-group projects.

Evidence of Efficacy

Project Northland used a pre-post, randomized community trial with longitudinal follow-up measures to determine the program's effectiveness. Reviewers found this approach to be an excellent example of a comprehensive evaluation of an alcohol prevention program. The strengths of the evaluation included a strong design, a high-intensity intervention, appropriate analyses, and a comprehensive set of measures. The credibility of the program had been established in repeated trials and in several refereed journals. The evaluation involved a large sample of adolescents, with 2,351 sixth-grade students at the 1991 baseline point. It also retained a substantial portion of them over the three-year period: 2,191 students at the 1992 sixth-grade follow-up; 2,060 students at the 1993 seventh-grade follow-up; and 1,901 students at the 1994 eighth-grade follow-up. The program demonstrated statistically significant effects, especially among nonusers at baseline, and provided considerable longitudinal evidence of the program's effectiveness in delaying the onset of alcohol and other drug use.

The evaluation used randomization at the school district level, with 24 intervention and reference school districts blocked into two groups, and student questionnaire measures assessing attitudes, beliefs, and use of drugs and alcohol. Results demonstrated consistent statistically significant differences at the end of the three-year intervention in favor of the treatment group on repeated survey measures, including students' tendency to use alcohol, recent alcohol use, cigarette use, marijuana use, peer influence, self-efficacy, and functional meanings of alcohol use. The program showed a differential effect for nonusers at baseline, indicating that the program was very effective in delaying the onset of alcohol, cigarette, and marijuana use among adolescents who had never used these substances at the sixth-grade baseline.

Professional Development Resources and Program Costs

The curriculum includes three teacher-friendly guides for grades six, seven, and eight that provide strategies, resources, implemen-tation plans, and materials needed for optimal benefit. Student-specific handouts enhance ease of delivery at all grade levels.

Training is strongly recommended for administrators or prevention coordinators to understand thoroughly the research, rationale, and strategies for effective implementation. Participants will receive key implementation tools and technical assistance in developing an individual plan. In order best to meet conditions for replication, classroom teacher training for staff delivering curriculum in grades six, seven, and eight is also suggested. For current costs on all materials and training services, please call Hazelden Publishing at 1-800-328-9000.

Project T.N.T.: Towards No Tobacco Use

Project T.N.T.: Towards No Tobacco Use is recommended as an exemplary Safe, Disciplined, and Drug-Free Schools program.

Program Description

Project T.N.T.: Towards No Tobacco Use is a comprehensive, 10-day curriculum that provides students with the information and skills they need to say no to tobacco use. The program educates students about the short- and long-term negative physiologic and social consequences of tobacco use, while addressing social influences and peer norms and building refusal skills. The program addresses both cigarettes and smokeless tobacco.

The program goals for Project T.N.T. are to reduce the initiation of cigarette smoking and smokeless tobacco use in young teens and to reduce the frequency of cigarette smoking and smokeless tobacco use in young teens. The program combines numerous research-based approaches for program delivery. It teaches the replacement of negative thoughts about resisting peer pressure with positive thoughts, provides an interactive approach to explain the physical consequences of tobacco use, and uses novel games to reinforce learning.

Designed for use in middle schools and junior high schools, the program consists of 10 lessons to be presented over a two-week period, beginning in either grade five, six, seven, or eight. Each of the 10 core lessons lasts 45 to 50 minutes and can be delivered over a two-week period or over as many as four weeks. Two booster sessions are held the year after the program begins.

The curriculum consists of a teacher's manual with step-by-step instructions for completing each of the 10 core sessions and the two booster sessions, a student workbook, and two supplementary or optional videos.

Program Quality

The program's goals were found to be explicit, clear, and appropriate to the audience. Both the rationale behind these goals and the program activities were compelling to the reviewers; most significantly, the program demonstrated nicotine's addictive nature and emphasized how that quality necessitates a continued commitment to preventing tobacco use among young people. Materials were noted by reviewers to be of significant variety and were not found to be culturally biased or insensitive to diverse ethnic groups.

Evidence of Efficacy

Reviewers concluded that the evaluation design of Project T.N.T. was ambitious, very strong methodologically, and well constructed for strong internal validity. There were large samples, multiple schools, identifications of different sub-treatments, random assignments, and sophisticated analyses of the data. Appropriate tests were made for gender and setting effects. The program presented evidence of effectiveness in attenuating increases in initiation and weekly use of cigarettes and smokeless tobacco for seventh-grade treatment students. Reviewers commented on the impressiveness of a program that could demonstrate results a full two years after a 10-day treatment intervention.

The pre-post evaluation design involved the random assignment of 48 schools to four treatment conditions and one control. The schools were split into two cohorts. In Cohort 1, a 20-page questionnaire was administered pre-post to 6,716 students in seventh grade from treatment and control schools and, during a two-year follow-up, to 7,219 students in ninth grade. In Cohort 2, a sample of students in each school was given the pre-post questionnaires. The program reported that at the end of the two-year follow-up, compared with control group schools, students in Project T.N.T. schools reduced the initiation of cigarette use by 26 percent and smokeless tobacco use by 30 percent weekly. The regular use of cigarettes decreased by 50 to 60 percent and of smokeless tobacco by 100 percent. Statistically significant differences were found on a variety of measures for some of the treatment groups compared with the control group.

Professional Development Resources and Program Costs

Two days of teacher training are recommended. There are two types of training: educator training--a two-day workshop designed to provide health educators with the knowledge and skills needed to implement Project T.N.T.--and train the trainer--a three-day workshop designed to provide trainers with the knowledge and skills needed to train health educators to implement Project T.N.T. Costs vary, depending on the size of the group, location, duration, and extent.

Program materials cost $45 for one curriculum, which consists of a teacher's manual and one student workbook. The student workbook, in either English or Spanish, is $18.95 for a set of five. (Current costs need to be verified with the program.)

For Further Information

Second Step: A Violence Prevention Curriculum

Second Step: A Violence Prevention Curriculum is recommended as an exemplary Safe, Disciplined, and Drug-Free Schools program.

Program Description

Second Step: A Violence Prevention Curriculum is a school-based social skills curriculum that teaches children to change attitudes and behaviors that contribute to violence. The goals of Second Step are to reduce aggression and to promote the social competence of children from preschool through ninth grade. The program also addresses a range of other behaviors that may be warning signs of violence and aggression, including acting with extreme impulsiveness, interrupting, calling people names, bullying, and threatening.

Second Step is based on research that suggests that the acquisition of key social competencies will decrease children's risk for engaging in destructive behavior and will expand their repertoire of pro-social skills. Second Step addresses three key pro-social skills: empathy, impulse control, and anger management.

The program is delivered once or twice a week, and lessons vary from 20 minutes in the lower grades to 50 minutes for older children. There are about 20 lessons for each grade level. For preschool and elementary school students, the Second Step curriculum consists of three kits: preschool/kindergarten, grades one to three, and grades four and five. Each kit includes a set of photo lesson cards, classroom posters, a teacher's guide, a classroom video, and a parent information video. The pre-K kit also includes a tape of songs and puppets. Lessons in the middle school and junior high curriculum are divided into three levels. Each contains discussion lessons, overhead transparencies, reproducible homework sheets, and a live-action video. At all grade levels, a teacher's guide explains the underpinnings of the program and provides implementation information to schools.

A video-based parent program, "A Family Guide to Second Step," is led by a Family Guide group facilitator in six group meetings. The program is designed to familiarize parents with the Second Step curriculum and help them reinforce the pro-social skills their children learn in their lessons. A Spanish supplement to Second Step is available for use by teachers in Spanish language or bilingual classrooms.

Program Quality

Reviewers noted the correlation between the program's goals and the practice skills taught in the curriculum. They also highlighted the program's focus on mastery of three important areas: empathy, impulse control, and anger management. Reviewers found that the strategies to achieve these goals and the rationale behind them had a strong congruence and were very logical. Because the program drew experiences from its participants, reviewers found it to be culturally appropriate for the intended population.

Evidence of Efficacy

Second Step provided overall evidence of efficacy based on data from three evaluation studies: a pre-post randomized control group study, a pre-post nonrandomized comparison group study, and a pre-post treatment-group-only study. Additional studies are in progress, including a three-year longitudinal evaluation.

Reviewers cited in particular two strengths of the evaluation data: 1) the excellent triangulation of teacher rating, parent report, and classroom observation measures; and 2) the use of well-known teacher and parent measures with a history of established reliability and validity. Reviewers specifically noted the rigor of the one-year, pre-post randomized clinical trial, involving 418 second- and third-grade students from six intervention schools and 372 second- and third-grade students from six control groups, in which the 12 schools were paired to ensure socioeconomic and ethnic comparability. This study yielded statistically significant treatment and control group differences on observational measures of behavioral outcomes, including a decrease in physical aggression and an increase in neutral/pro-social behavior. A six-month follow-up showed these observational effects remained for the most part.

Preliminary results of the pre-post nonrandomized comparison group study indicated that Second Step participants in grades six and seven in five sites showed a statistically significant reduction in self-reported attitudes endorsing the use of physical and relational aggression and in the perceived difficulty of behaving pro-socially. The pre-post treatment-group-only study used observations of third- and fifth-grade teachers' practices during the first week of the school year, combined with students' perceptions in the spring. Recommended teaching practices were significantly predictive of a greater sense of community among students, which in turn predicted a lower number of self-reports of student aggression.

Professional Development Resources and Program Costs

Training for teachers is available through a train the trainer model. Educators who receive the intensive training as Second Step trainers gain the skills, tools, and resources that enable them to train their school staff to teach the curriculum to students. In addition, the developer provides training for Family Guide facilitators, refresher/booster training sessions, and training programs for staff other than teachers. Free implementation planning assistance is available to schools via telephone.

Typical program costs are as follows: the pre-K kit, $259; the grades one to three kit, $269; the grades four and five kit, $249; materials for three levels of middle school and junior high school, $545; the Family Guide kit, $475; and the Second Step Training for Trainers, a three-day workshop for one trainer, $379. (Current costs need to be verified with the program.)

The Strengthening Families Program: For Parents and Youth 10--14

The Strengthening Families Program: For Parents and Youth 10--14 is recommended as an exemplary Safe, Disciplined, and Drug-Free Schools program.

Program Description

The long-range goal of The Strengthening Families Program: For Parents and Youth 10--14 (formerly called the Iowa Strengthening Families Program) is to reduce substance use and behavioral problems during adolescence. Intermediate objectives of the curriculum include improving skills in nurturing and child management by parents, improving interpersonal and personal competencies among youths, and improving pro-social skills in youths. The curriculum is a universal preventive intervention designed for parents of all educational levels and their young adolescent children.

The rationale for this program is based on enhancing protective factors and reducing risk in the family environment. A substantial body of literature supports a strong predictive relationship between ineffective child-rearing in early adolescence and delinquent behavior in later adolescence.

The Strengthening Families Program includes seven 2-hour sessions for parents and youths. Parents and youths attend separate skill-building sessions for the first hour and spend the second hour together in supervised family activities. The program is designed for eight to 13 families and is typically held in a public school, church, or community center. Each session requires three facilitators: one for the parent session and two for the youth session. All three facilitators offer assistance to families and model appropriate skills during the family session. Four booster sessions are designed to be used six months to one year after the end of the first seven sessions to reinforce the skills gained in the original sessions.

Program materials consist of nine videotapes (six for parent, one for each youth, and two for family sessions) and a 415-page leader's manual containing a teaching outline; a script for the videotapes; detailed instructions for all activities in sessions one through seven; master copies for each parent, youth, and family worksheet and homework assignment; a master copy of the program flyer; a list of materials; ordering information; and evaluation instruments. The narrators and actors in the video vignettes are African American, Hispanic, and white. Two additional videotapes and a separate 215-page manual detailing instructions for four booster sessions for parent, youth, and family sessions are also part of the program.

Program Quality

The reviewers found the goals of this program explicit and based on solid research. They rated highly the program's approach, which assumed a developmental perspective with families exerting relatively more influence on young and pre-adolescents than on older youths. The intensified focus on high-risk moments of transition from elementary to middle or junior high also was highly commended by reviewers for effective intervention timing.

Evidence of Efficacy

Reviewers found that the program used rigorous pre-post treatment vs. control evaluation methods and provided evidence of positive treatment results, especially in the area of decreased drug and alcohol use among youths. The program's five-year longitudinal evaluation design used random assignments into experimental and control groups followed by a series of confirmatory tests of equivalence. The study addressed attrition rates and found no evidence of differential attrition at any of the post-test or follow-up data collection points. Reviewers noted that the integrity of the instruments was well substantiated, and that the data analyses were appropriate in type and rigor.

Statistically significant results for both the youth and the parent components of the program attested to the credibility and soundness of the evidence. Surveys were used to measure youth outcomes; questionnaires, interviews, and direct observations were used to assess parenting behaviors. The methodology included a range of sophisticated analyses that permitted data to be explored and explained in very convincing ways.

The results were reported for a five-year longitudinal evaluation with 11 schools, each assigned to the experimental group or minimal contact control conditions, totaling 238 experimental and 208 control group sixth-grade students and their families. The program also conducted a 10th-grade follow-up with both groups. Reviewers found that the experimental group showed statistically significant reductions in conduct problems and the use of tobacco, alcohol, and other substances. At the 10th-grade assessment, the experimental group had significantly lower alcohol and tobacco initiation index scores than the control group.

Professional Development Resources and Program Costs

The program requires two days of facilitator training. Three days of training are recommended for groups conducting a scientific evaluation of the program and for groups requiring adaptation of the program for different ethnic groups and families that do not speak English. Consultation and technical assistance are available by telephone and e-mail for no charge after trainings. All materials for program implementation provide easy-to-follow instructions.

Leader's manuals are $175 each, and the set of nine videos is $250. Program supplies, not including general supplies, cost about $10 per family. In addition to the two separate rooms needed for the parent and youth sessions, two televisions and VCRs, flip charts or erasable boards, and a slide projector are needed. (Current costs need to be verified with the program.)